Disordered eating

You count calories, you exercise daily, you’ve gone on crash diets to lose weight — but you tell yourself you’re just “living healthy.”

While these may not be symptoms of a clinically diagnosable eating disorder, experts and student activists on campus say that they constitute a pattern of disordered eating — a condition that may affect as many as 80 percent of young women on college campuses, said Kristin Baxivanos ’10, the president of Eating Concerns Hotline and Outreach.

“Excessive dieting, exercising — these abnormal habits are becoming normal,” she said. “There’s a problem with body image on campus, and students are aware of it.”

In a study published in the Journal of American College Health in 1995, 91 percent of women recently surveyed on college campuses had attempted to control their weight through dieting, and 22 percent dieted “often” or “always.”

Such patterns of behavior are much more prevalent than the three most common diagnosed eating disorders: anorexia nervosa, bulimia nervosa and binge eating, which affect 0.5 percent, 2 percent and 4 percent, respectively, of high-risk populations, said Katherine Henderson, clinical director of the Yale Center for Eating and Weight Disorders.

Henderson said “disordered eating” is not officially recognized as a clinical psychiatric disorder like bulimia, anorexia or binge eating, but it is still a useful way of describing a common pattern of behavior.

“A lot of people don’t meet technically criteria for a full-fledged eating disorder but still have a lot of distress around their eating,” she said. “But the symptoms can still be clinically significant.”

The condition — like other clinically diagnosable eating disorders — correlates strongly with incidence of perfectionism, she said, which may put achievement-oriented Yale students at a higher risk than the average college student.

Baxivinos said the culture of high achievement at Yale may lead students to equate seeking perfection in their academic lives with seeking perfection in their personal lives — a tendency that can translate into an unhealthy pre-occupation with body and appearance.

The stressful academic pressure-cooker that is Yale can also exacerbate this tendency, Bryna Harrington ’08, ECHO treasurer, said.

“If there’s a lot of stress, food may be the only thing you can regulate or control,” she said.

In fact, the transitionary nature of college may in itself precipitate an eating disorder, since that period in people’s lives can be associated with stress or trauma, Henderson said.

Ali Hamedani ’08, a freshman counselor in Davenport, said that at the beginning of the year, freshman counselors are given a full day’s training on eating-disorder issues, which he said he considers a “huge problem” on campus.

Adjusting to the academic and social pressures at Yale, he said, can create concerns about eating among freshman, who are eager to make friends or be accepted.

“College is the time when image matters a lot. Image weighs in heavily into first impressions,” Hamedani said. “[Freshmen] might feel that’s the only way that they can fit in.”

But while the roots of disordered eating may be similar to those of medical eating disorders, its treatment may be more complex.

To add to the already complicated set of barriers college students seek when facing help, unhealthy food-related behaviors might be even more difficult to detect and correct than full-fledged eating disorders, since students may not even consider them to be unhealthy, Harrington said.

She said the line between cutting calories to stay fit and to lose weight can often be hard to draw, even for the individual in question.

“A lot of disordered eating goes unnoticed consciously,” she said. “The student has an image in their head of the anorexic who weighs a third of what she does, and thinks, ‘That’s not me, so I’m fine.’ People don’t think they need clinical help.”

But Hamedani said unhealthy eating behaviors should be treated seriously because they may often be a warning sign that an individual is at risk for developing an eating disorder in the future.

Eating concerns brought to the attention of freshman counselors usually do not come from the affected individuals themselves, but rather from concerned friends or roommates, he said.

Once in the loop, the freshman counselor’s role is that of an intermediary rather than a mental health specialist, Hamedani added.

“Our ultimate goal is to go seek professional or medical expertise,” he said. “They would be more qualified than we could ever be on this subject.”

If they choose to seek it, students have access to a range of options, from anonymously calling the Walden Peer Hotline or seeking counseling at Yale University Health Services.

But many never get that far.

Baxivanos said prolonged eating disorders can lead to a whole constellation of other issues — such as depression, anxiety and social isolation — that may further impede the process of recovery. Rates of recovery from eating disorders are correlated to their clinicity: The longer an individual has had disordered eating behaviors, the poorer the treatment outcome, Henderson said.

“I tell people, if you think there is a problem, get on it,” she said. “It only becomes more habitual down the road.”